Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States

Am J Public Health. 2014 Feb;104(2):e52-9. doi: 10.2105/AJPH.2013.301709. Epub 2013 Dec 12.


Nonmedical prescription opioid misuse remains a growing public problem in need of action and is concentrated in areas of US states with large rural populations such as Kentucky, West Virginia, Alaska, and Oklahoma. We developed hypotheses regarding the influence of 4 factors: (1) greater opioid prescription in rural areas, creating availability from which illegal markets can arise; (2) an out-migration of young adults; (3) greater rural social and kinship network connections, which may facilitate drug diversion and distribution; and (4) economic stressors that may create vulnerability to drug use more generally. A systematic consideration of the contexts that create differences in availability, access, and preferences is critical to understanding how drug use context varies across geography.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Economics
  • Family Relations
  • Humans
  • Opioid-Related Disorders / economics
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / psychology
  • Perception
  • Prescription Drug Diversion / statistics & numerical data
  • Prescription Drugs*
  • Prevalence
  • Risk Factors
  • Rural Population / statistics & numerical data*
  • Social Environment
  • Social Support
  • United States / epidemiology
  • Urban Population / statistics & numerical data*


  • Prescription Drugs